Fundus examination

1. FUNDUS
EXAMINATION
SOUMITRA DAS

3. METHODS OF EXAMINATION
DIRECT OPHTHALMOSCOPY
INDIRECT OPHTHALMOSCOPY
INDIRECT SLIT LAMP BIOMICROSCOPY

4. Why do we dilate pupils?

5. PUPILLARY DILATION
Combination of phenylephrine [2.5 %] &
tropicamide [1 %]
then eyes closed
Dilation attained = 15-30 min
Normal reactivity = 4 - 8 hrs
Conditions which to avoid : iris supported lens
shallow AC

6. DIRECT OPHTHALMOSCOPY

7. Viewing ocular media
◦ Observe red reflex
◦ Look for media opacities
◦ Cataracts
◦ Corneal scars
◦ Large floaters
Right eye to right eye
Left eye to left eye

9. •An erect upright virtual image
•Magnification = 15 x
•Field of view = 5 degrees
•No stereoscopic view
•Several plus and minus dial up lenses
• Structures - optic nerve, blood vessels of posterior pole
fovea

10. Advantages
◦ Portable
◦ Easy to use
◦ Upright image
◦ Magnification  15x
◦ Can use w/o dilation
Disadvantages
◦ Small field of view
◦ Lack of stereopsis
◦ Media opacities can degrade image

11. - retinal arterioles - exudate
retinal haemorrhage edema
microaneurysm
attached retina - vitreous opacity
hole /break vitreous bleed
- Retinal venules - pigmentation
detached retina detached choroid
outine of break
- ora serrata /drusen
hyperpigmentation
Colour codes :

12. Vitreoretinal chart

13. Indirect ophthalmoscopy

14. condenser
Inverted Fundus
Image

15. •An inverted reverse real image
•Magnification = 2 to 4 X
•Field of view = 40 to 50 degrees
•Optimal working distance = 40 to 50 cms
•Good illumination & stereopsis
•Ease of use with scleral indentor
•Lenses from 14 to 30 D range

16. Headset correctly
positioned
Optimizing viewing
distance

17. Monocular or binocular
Advantages:
◦ Wide field of view
◦ Binocular instruments provide stereopsis
Disadvantages:
◦ Requires more skill
◦ Decreased magnification (3x)
◦ Requires dilation
◦ Inverted image

19. Indirect slit lamp biomicroscopy

20. •Field of View & Mag:
• FOV <indirect but >direct
• varies w/lens & slit lamp mag
•Inverted image
•Stereopsis
•Dilated pupil
•Requires skill

21. Slit-Lamp BIO
 An inverse real reversed image with hand
held lenses
 Field of view = 30 to 40 degrees
 Lens power = + 78 or + 90 D , other
lenses= + 60 to 132 D
 Magnifying knob to 10 X or 16 X

22. Optic disc
DISC:
DIAMETER – 1.5mm [1 disc diameter]
COLOR – Pale pink
SHAPE – Circular
EDGES – Regular
TERMINATION OF ALL
LAYERS EXCEPT NFL
CUP: C/D ratio – 0.3 to 0.4

23. Vessels
RETINAL SYSTEM : CENTRAL RETINAL ARTERY
AND
CENTRAL RETINAL VEIN
4 major branches
Arterioles, Venules
Capillaries
CILIARY SYSTEM : POST.CILIARY ARTERIES
Choriocapillaries

24. MACULA
Specialised region of retina
Diameter – 5.5 mm
Location – 2 DD - temporal margin of disc
Color – Yellow; deep pigmented
4 zones : Foveola -0.35 mm
Fovea -1.50 mm
Parafovea
Perifovea
Retinal vessels
Cilioretinal artery

26. Glaucoma

27. Optic Disc swelling

28. AION

29. Optic disc atrophy

30. Mylinated nerve fibre

31. RP

33. DR

36. HR

37. THANK YOU